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Immediate denture

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Immediate denture

  1. 1. Immediate Denture Dr. Mualyed. Malimoud. Buzayan, BD8 Maeinbant Maeaysia AF AAMP MSA
  2. 2. Are they the same personim
  3. 3. llll! llVlEDlA"ll"E DENTURE > Any removable dental prosthesis fabricated for placement immediately following the removal of a natural tooth/ teeth > Immediate dentures are denture constructed before all of the remaining teeth have been removed and are inserted immediately following removal of the remaining teeth. > An immediate denture may replace one tooth or all sixteen teeth in either the maxillary or the mandibular arch or in both arches.
  4. 4. 77f; e~: j} ii i l"€T‘1‘. lTn€ll‘CS : 1. Compatibility with the surrounding oral environment. 2. Restoration the masticatory efficiency within limits. 3. Harmony with the functions of speech respiration and deglutition. 4. Esthetic acceptability. 5. Preservation of the remaining tissue.
  5. 5. yr ral . I-; . in-. .1-we new 3 pa : , = = * X/ ff‘ ‘ ’r * 4- ‘ . my. 9.1. . . s‘~a- V4 ‘NI . o' I; _ . The patient does not need to go through edentulous period of healing. There is usually less pain because the denture acts as a protecting splint. Less change in muscle and supporting structures, and vertical dimension is maintained. There is likely to be more lasting stability and better resiliency (edentulous mouths without a protective covering lose resiliency) The patient can masticate food and major dietary modification. Appearance is affected minimally, since cheek and lip support are maintained face height is also maintained and the tongue does not spread out as a result of lack of contact with teeth.
  6. 6. l D In I I A surgical stent and protective bandage helps to reduce bleeding Protect the tissues at the sensitive extraction sites from irritation Prevents patient embarrassment Promotes patient health and healing post extraction. Provides a guide for optimal individualized patient esthetics and for V. D.O Establish the speech patterns more easily
  7. 7. I I7 l 4 "ff- s~‘ 4.‘ A A--,9-‘Cs . . l 4.. f r f. F l 5). ; r ‘ rat __ 35‘ . . v‘ ‘'. «a ‘at. r “um. :. l . V-vs ‘hi So" '- ‘% 1. More maintenance work is required than those with the conventional service. 2. Interim relines with tissue conditioners will be needed periodically. 3. The immediate denture does not replace the stimulation that was supplied to the bone by the natural teeth. 4. The procedures are precise and time consuming require more appointments. 5. There is no opportunity to observe the anterior teeth at the try-in appointment; therefore the esthetic result cannot be evaluated. 6. Increased complexity of clinical procedures 7. Gross irregularities of teeth make processing difficult, e. g. bulbous tuberosities/ tori. 8. Retention is potentially less than the optimum.
  8. 8. 1* Rev - - re- 5 - gg. ir38.‘li§l~C E3 : Patient is unavailable for appointment. Patient is debilitated or with Systemic conditions (poor surgical risk) Acute infections that require drainage Emotionally disturbed or diminished mental capacity and Indifferent patients Patient who have undergone Radiation therapy (extraction itself is contraindicated). Patient with a severe Gagging reflex. Patients with extensive bone loss
  9. 9. IMMEDIATE DENTURE TYPES: According to the denture’s flanges shape l Flanged type 2 Partial flanged 1 Open face (Socketed type) Types of immediate denture: (a) complete flange; (b) panial flange: (c) open face. According to the surgical alveoplasty performed I With surgery (Surgical Alveoloplasty) 2 Without surgery (Surgical Alveoloplasty)
  10. 10. Flanged denture Advantages 1. Retentive 2. Easier to reline and rebase 3. May be difficult to place where there is an undercut.
  11. 11. Open-face dentures socketing > Socketing anterior teeth on an open-face denture is to maintain an acceptable appearance in the immediate post-extraction period (teeth appear as emerging from the normal gingiva) by extending the necks of the denture teeth into the sockets » The socketing of the artificial teeth means putting the artificial teeth deep (around 2mm) in the gingiva, just enough to compensate for the gingival retraction that occurs immediately after extractions.
  12. 12. > The amount of gingival retraction will depend on the degree of pocketing and bone loss that is present around the natural (some times socketing more than 2mm (up to 5mm) would be needed) > Without socketing, a gap would appear between tooth and mucosa. teeth. These aspects should therefore be assessed before deciding ‘
  13. 13. The socket depth should not exceed 5mm labially and 2mm palatally. The sockets should not be carried too far towards the palatal side i. e the socket should slope from the palatal margin upward toward the labial aspect. The direction of the socket should follow the long axis of the tooth. Long axes of the teeth marked on the cast to assist in g ’ i / { _{, l ' placing the artificial "', /tf~/ ) k ; teeth in similar A _. _ . W 1 V. ,' ‘ positions.
  14. 14. x rt ~ ‘ . ‘ i‘ ‘ i 2‘ *1 K §‘‘%, :>%i t&: § "_ . ‘X ~ uh ( ‘; }}(: }§‘: ;-§‘*. ‘ ‘NB ‘y, _ . it
  15. 15. General notes Socket Fit Denture are: 1.The teeth sit into sockets of the extracted teeth, gives more natural appearance . Esthetically good initially a 3. Contraindicated in mandible because of poor stability of lower denture during function 4 . Prone to loss of esthetic as resorption continues (Gap formation) 5. Difficult to reline/ rebase or changed to flanged type 6 . Have poor retention Wherever possible, a flange denture should always be designed.
  16. 16. Tissue damage resulted from the socket fit denture
  17. 17. Alveolotomy following interseptal alveolectomy This procedure is intended to eliminate moderate labial alveolar undercuts so that a flanged denture can be used without that flange distorting the upper lip unduly. The denture is constructed on a working cast which is trimmed to the anticipated contour of the ridge after surgery as follows:
  18. 18. (l) The gingival margins are marked and the teeth removed. (2) Guidelines are drawn on the cast showing the areas and amount of bone needed to be removed. (3) All that part of the cast contained within these guide lines is trimmed away and the edges are rounded over. (4) A clear acrylic template is processed on a duplicate of this cast and is used as a guide to control the amount of bone removal at operation (the immediate denture itself can be duplicated in clear acrylic stent).
  19. 19. The surgical procedure involves: (1) Extraction of the teeth. (2) Removal of the associated interseptal bone. (3) Collapse of the labial cortical plate of bone and mucoperiostium, back into the resulting ‘ gutter‘. (4) Insertion of the clear acrylic template to check if bone removal has been sufficient. Blanching of the mucosa is clearly seen beneath the template in any area where there is excessive pressure. (5) Suturing of the sockets and insertion of the immediate denture.
  20. 20. Goals oi" aliletoloplasizy: Eliminate bony projections that result in undercuts Improve the path of insertion of the prosthesis Eliminate bony sources of irritation
  21. 21. IMMEDIATE DENTURE TYPES: According to timing of teeth extraction and denture purpose 1 - Conventional immediate denture (CID): A complete or removable partial denture or overdenture fabricated for placement immediately after the removal of natural teeth. The posterior teeth would be extracted and allowed to heal before the anterior teeth extraction The denture is intended to be relined to serve as the long—term prosthesis. Indications I For patients with periodontally weak teeth indicated for extraction. For socially active people who are very self conscious about their appearance.
  22. 22. 2 - Interim immediate denture (IID): All remaining teeth are extracted on the same day and the immediate denture is inserted on the same day. After healing is completed, a second, new complete denture is to be fabricated as the long—term prosthesis. A dental prosthesis to be used for a short interval of time for reasons of esthetics, mastication, occlusal support, or convenience, until more definitive prosthetic therapy can be provided
  23. 23. 3 - Transitional immediate denture. It is an interim immediate denture. However, it is a removable partial denture serving as an interim prosthesis to which artificial teeth will be added as all natural teeth are lost. A transitional denture may become an interim complete d. when all of the natural teeth have been removed from the dental arch.
  24. 24. intended as a definitive or long-term prosthesis After healing is complete. it is relined usually only anterior premolars) are remaining (and possibly Usually has good retention and stability at placement, which is possible to maintain during healing Cost is less Treatment process takes longer than the III) because of a delay of 3-4 weeks for the posterior teeth extraction areas to heal before making the final impression. Generally indicated when only anterior teeth are present or few posterior teeth remain that do not support a partial denture Transitional or short-term prosthesis After healing. a second denture is made‘. it is kept as a spare denture usually both anterior and posterior teeth are remaining Usually has only fair retention and stability at insertion, which must be improved by proyisional relines Cost is higher ( two denture will be made) Treatment process takes less time than the CID as It can begin right away Generally indicated when there multiple anterior and posterior remaining or full arch extractions and/ or these teeth support. a removable partial denture that the patient desires to retain until insertion are teeth
  25. 25. At placement only anterior teeth (and premolars if any were kept) would be extracted Indicated possible if two extraction visits are Esthetic can not be changed (one denture) If all the posterior teeth are initially removed, the vertical dimension of occlusion is not preserved; ((opposing premolars can be maintained for this purpose)) No transitional denture At placement all the remaining teeth would be extracted Indicated if only one extraction visit is possible Esthetic can be improved in the second denture Because posterior teeth need not he removed before fabrication of the HD, the vertical dimension of occlusion may be preserved Can be made from transitional denture
  26. 26. I J CID clinical procedure The posterior teeth are extracted and the sockets are allowed to heal (This does not affect the aesthetics of the patient). An alginate impression is made with the help of a stock tray. and a diagnostic cast is prepared from the impression. Two layers of wax are used to block out the undercuts in the dentulous areas of the cast. A custom tray is fabricated over this cast elastomer is used as the impression material. Occlusal rims are fabricated over a temporary denture base covering the edentulous area. Posterior teeth setting and try-in are completed. The anterior teeth in the master cast are broken away and immed up to the cervical margin and smoothened
  27. 27. x The teeth arrangement should be in harmony with the existing teeth as well as the prosthetic teeth. » The denture is flasked, de-waxed, packed, processed and finished. IH During the insertion appointment, the remaining anterior teeth are extracted as atiaumatically as possible, preserving the soft tissues and bone.
  28. 28. aiaaiaaa ; ~‘ ° . "'”j““x§‘t". “(‘t''‘~“§'" I _ V _ . J -. ‘ s ‘ -. 5‘ i 7 7 ' I. ‘ ‘“i ‘-‘. T ’. ?"7 . T V i l 1‘ fiq . * . ' ‘J I x | I .7 ‘ v - " ‘v 7 " ' 5 'l‘ : . _ 1 ff ’ T _i_'. 'l ‘-_‘ 1 ‘i X / . ' ' V. l ‘ _' ‘ , I ' K‘: I H ‘ ‘ ‘ ll‘ T T T‘ ‘" ’U: ~'V" 5‘ Q» ‘l E‘ ‘s "s E‘ l it t . ‘ *1 c . it Q * ‘~. I 5 K 5 ‘ 3 l i N ‘i ‘ 5 ‘t“‘ I, __ ‘§' at ~ ~ . ‘$““ -. ‘ ‘‘~ ‘ ‘in . _. . ‘h . .
  29. 29. ‘ E ‘k. . K? g V I A, . ‘A 1‘ J ‘ 'i i K , ‘ I 9 ~ 4 : " :72: « i M ‘ii i‘~, , ‘ : ¢', ' §; .§%; i"l3;'§: .i, ‘~i§: §‘q; -?; ;i¢3{'i*§; ;"x; ‘-é‘~; ~{<""-§»; : ~. ~. .
  30. 30. / ixf. ‘ ' i l ‘- iii L' T - K‘ "' ' ’"‘V*l“ xx xix ; ‘ 3 x * I - ~. i‘
  31. 31. . NA zg‘ - l .4- .1: rig. » ‘1 r. ; ' -A ‘V v- 4- l ~A, -. W 4% l 1 .4 ‘ . ‘I i‘< . . 39 l "hi (:3 C1 KI ‘ . f t‘ l , l l It is the same as the CID except that there would be no two extraction visits, just one visit at time of Immediate Denture insertion.
  32. 32. Fabrication of spaced custom tray Fabrication of occlusal rim
  33. 33. ‘SK ' | 1;. ‘ aximx -I‘. x x x ’ ‘ ha‘ ' / " ‘ K n I " ‘ x xi ‘‘ ‘ ‘* , is‘ 5 N n‘ ‘ "‘V‘ ’V ' i"bt 5 “v ‘ v " ' " "' y’ ' "T " s’ "in" ‘w ' '» . ’ x s‘, , .h, ‘‘ < “ l)‘a xxx 1 . . 1 ‘ u, '1! A , _ , , in i 4 an . ”.7_<_i‘~§‘taiii: *. '_. .x__im. 15>. . El). it -2 xi. ‘ ii . ‘A at r 1 4 L . — pt ll , ‘ ‘ . .5: , — ~ A ; ""'”‘"* "nah ‘ V : “‘“‘‘V. } V "4 ‘"5’ ’ A V. A tt ‘~ 2‘ . ‘~‘~ -‘‘li§xi‘il xx ‘ ~ ‘i s s ‘ | __i 4,; . ' s v‘. ‘I as ‘~. ‘~. ' 55 ‘s x "L‘ l‘~. ‘-. l-. ls l5 l-l "’ _- Zr
  34. 34. t x ~ ~ vv , . . x s -‘“‘ , . ' ‘ , V i ; xi‘ ““ i I: ‘’“ a J ’* I ‘ _‘ iifiiii ' fa; r 1 K ml Apt K 1 ‘I
  35. 35. / . / . . ‘ W’ " s§’j . . . . l saw ll . , § ixiv"ii° Z ‘xx 3 . ./‘ y'{4 . I I 4, *l I ‘ / a‘ “I. I '1 ; xx ~ ‘Rx : . ', ',&x%‘: & i ii‘ . ;TL. .{&: »
  36. 36. DIAGNOSIS, TREATMENT PLANNING, AND PROGNOSIS Which Type of Immediate Denture Should Be Prescribed In some cases, the presence of numerous posterior teeth and the need for other hard and soft tissue related procedures can complicate treatment. In some patients, the sequelae of advanced periodontal disease, including aberrant occlusal relationships, might require a "staged" surgical approach to the final objective of a definitive prosthesis. Extracting the posterior teeth and performing other necessary procedures first in these patients can lead to predictable results for the CID. However for other patients, the idea of a period without posterior teeth is impossible to imagine.
  37. 37. Final Impression Options ~_
  38. 38. Final impression: Two types of final impression procedures are employed. the sectional (two stages) impression or the single impression: A- Sectional (two stage) impression technique: I - A special tray is constructed. C overing the edentulous area pOSt€l'lOl‘l_' and restuig on the luigual surface of the remaining anterior teeth. 3 _- The tray is border_mold_ed using green stick compound and then_the impression isinade into zinc oxide and eugenol impression paste (light body impression can be an altemative). - An overall impression (Pick up ) is made using alginate impression material in a suitable stock tray (sectional custom trav can be made to cove_r just the anterior teeth) to record the anterior teeth and relate the previous impression of the edentulous area to these teeth . Indications I The remaining teeth are mobile (that can be accidentally extracted with impression) : severe labial under cuts present ‘ the anterior teeth are protruded or labially inclined.
  39. 39. ‘h R . / K i§ ‘xi i . . ,, “§ ifxilx X i D‘ g M M §ti. ‘ ‘i I
  40. 40. B- Single Final Impression Technique: I Spaced custom tray is constructed over the master cast covering both the anterior teeth and the posterior edentulous area I J The border molding procedure is performed using low fusing compound and the impression is then made using appropriate elastic impression material (rubber base impression material are preferred) to avoid impression locking into the undercuts Indications I. The remaining teeth are not mobile (that can be accidentally extracted with impression) There are no severe labial U) I. ) under cuts present the anterior teeth are not protruded or labially inclined. -£-
  41. 41. When there are mobile teeth and the sectional tray was not made the teeth’s place utility wax around the cervical portion of existing dentition to allow for easy removal of tray. Make an alginate impression and pour a stone cast. Use wan/ . to block out large iriierderital arribrasures
  42. 42. Jaw Relation > Evaluate the current VDO (vertical dimension of occlusion) to assess if there is loss of VDO or not. I If there was no loss of VDO ( free way space is within the average), and there were enough teeth, the jaw relation is registered at centric occlusion If there was loss of VDO ( free way space is more than the average), the jaw relation is registered at centric relation Also if there was no teeth posteriorly the centric relation would be registered I J
  43. 43. Methods of establishing occlusal relationship 1 - If there is sufficient number of teeth; either by: a- Direct apposition of the casts, or, b—Interocclusal record with posterior teeth remaining using inter-occlusal wax record. 2- If there is no sufficient number of teeth (like Kennedy class I and II, and in cases of one of the arches is edentulous): Occlusal relation using occlusal rims on recorded bases.
  44. 44. DUPLICATING THE PAT| El! T'S ANTERIOR NATURAL TEETH The natural teeth appearance can be preserved and duplicated in the immediate denture. This would make the patient more happy and satisfied. Duplicating the anterior teeth is remarkably simple and rewarding. This can be performed either by: l. Fabricating the artificial teeth from acrylic resin (method one) This is done so that all the teeth have the same shade because it is impossible to match self-cure teeth with factory made teeth. Preliminary alginate impressions poured twice (one with teeth in wax and the other one in stone). Before pouring the duplicate cast, molten wax is poured into the teeth (to be extracted) of the refractory impression. Once the wax cools; the duplicate cast is poured in dental stone. The duplicate cast will have all the anatomical structures in dental stone except the teeth to be extracted, which will be in wax.
  45. 45. The other master cast which is totally made of dental stone is the one used for adapting the base plate, fabricating the occlusal rim to register the jaw relation, and teeth arrangement at try in stage. « After try-in, the trial denture is shifted to the duplicate cast with wax teeth. Hence, it would be a trial denture, which replaces the missing teeth and a wax form, which replaces the teeth to be extracted
  46. 46. > At the processing procedure: > The wax pattern is flasked and de-waxed. The teeth to be extracted will be hollow in the flask mould. > The arranged artificial prosthetic teeth are removed. > Self-cure acrylic is placed into all the teeth moulds (the ones to be extracted and the ones already extracted) in the flask using sprinkle-on method > the usual packing and processing is then followed
  47. 47. 2. Fabricating the artificial teeth from acrylic resin (method two) Anterior relieved custom tray is formed and an impression of the cast anterior teeth is taken. Then The impression is then filled with wax above the level of the gingiva and allowed to set. The wax is carefully removed from the rubber-base material and trimmed of excess gingival areas, leaving the teeth and approximately 1 min of gingiva remaining. The wax pattern is then invested in a suitable flask. And suitable color heat—cured acrylic resin is packed into the mold and processed. The teeth are then removed as a block of six teeth. Finished and polished. They can then be set into their proper place on cast and waxed to place.
  48. 48. > Light cured resin can be used directly into the mould made by impression without using wax pattern method
  49. 49. 3- Produce a labial index of the natural teeth before they are cut off the cast. The index can be produced quite simply by molding silicone putty against the labial surface of the teeth and ridge on the cast. The artificial teeth are then set into the index while it is held against the cast. f "if, x ‘ ) / I la‘ . r .1 v 1/ ‘vi . lirul
  50. 50. Silicone index to guide incisal edge placement
  51. 51. Saw 4* . g.: _‘ -_, -x 3 run (xi T (D (. .1». Teeth can set all the same time or using the Alternating Tooth Setup Technique 1 Trim and set only one anterior tooth at a time Alternate from side to side to preserve the natural neighboring tooth as angulation, length, and contour orientation (duplicating the natural teeth appearance and position when they are reasonable and acceptable. ej
  52. 52. Cast Trimming Generally The teeth are removed from the cast in a manner that They are not cut below the gingival crest The terminal 5 mm of labial gingiva should be trimmed in the manner shown below so that the denture gingiva may not appear too thick Remove stone tooth without obliterating the gingival outline mark and shape into a gentle convex shape Around 5 mm l l T e Gingiyal Outline Gentle C‘"“'°‘ Mark Shape
  53. 53. General notes Surgery and insertion of the denture DThe first step: preparing the patient for the surgery in case patients that suffering from systemic diseases such as diabetes and hypertension and other systemic diseases precautions should be taken before this surgical procedure so the appropriate dental managements for each patient with systemic diseases should be preformed U The second step: Extraction of the teeth that were decided to be extracted in the first appointment and in case of multiple extraction of the posterior teeth start extracting of the posterior teeth toward the anterior teeth to prevent damaging the wound to and allow healing of posterior area and improve the adaptation of the denture over the alveolus and tuberosity.
  54. 54. ._l The third stage: After extraction alveolectomy is done in the area by simple recontouring or an interseptal Alveoloplasty preserving as much as possible of the vertical height and cortical bone that bony recontouring and elimination of gross irregularity is completed the tissue is approximated with digital pressure and surgical guide is inserted and any area of tissue blanching or irregularity are then reduce until surgical guide is adapted to the alveolar ridge in all areas. 3 The forth stage: Incision are closed with continuous or interrupted suture and the use of suture will depend on the number of extracted teeth. _i The fifth stage: Use of tissue conditioner in the denture for better retention and faster healing. _l The final step: Insertion of the immediate denture.
  55. 55. Post-operative instructions I You must leave your dentures in your mouth For The First 24 hours. Removing the dentures will not decrease gain due to (lie extractions. Swelling may occur, and if you remove your dentures, zou may not be able to rernsert tlzem. * e V 2 Avoid. ‘ ° Spitting, rinsing - Strenuous activity - Alcohol, smoking = Holding Ice Packs Against Your Face in the area of the extractions (no more than 20 rninutes/ hour for the first 24 hours may reduce swelling). 4 After 24 hours, use a heat compress. < Take prescribed medications as directed. The denture will act as a bandage and help to limit bleeding and prevent breakdown of the blood clots that form in the sockets.
  56. 56. u Although bleeding is normally minimal, you must remember that a few drops of blood will color your saliva pink. * Your diet for the first 24 hours should be restricted to liquids or soft foods. x After the 24 hour appointment, your dentures should be removed for cleaning after meals. -» After 24 hours, you should begin removing your dentures at night. Removing the dentures allows small blood vessels to enlarge and provide nourishment to the tissues supporting the dentures.
  57. 57. Review a ppointmerit. It is important to review a patient with an immediate denture at regular intervals especially in the first few weeks and months. The initial days are primarily concerned with the postoperative care of the healing tooth sockets, while the later reviews are directed at the management of resorption. A simple time table for reviewing a patient is as following: 1- at 24 hours, a general check is made of the over all comfort and borders of the dentures and to ensure no major ulceration has occurred and that the socket are healing well, try to avoid occlusal adjustment. 2- at 48 hours, patient is seen for sore spot. 3- at 1 week, a more detailed check and occlusal adjustment of dentures can be made, removal of suture and changing of tissue ' c- ditioning material.
  58. 58. 4- at 1 month, the socket has healed and chair side temporary reline may required. 5- at 3 to 6 month, the management of loss of fit of the denture owing to bone resorption is undertaken, this may involve relines and / or rebases, which are taken either chair side or with aid of the laboratory. 6- at 1 year, a new denture is made (in case of IID). ‘_
  59. 59. Thank You ‘_
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